.In den Medien wurde dem Adipositas-Medikament Wegovy viel Aufmerksamkeit zuteil. Welches Potenzial hat das Präparat?
Wir rechnen damit, dass sich der Markt für Medikamente gegen Fettleibigkeit zu einem der bedeutendsten Märkte im medizinischen Bereich entwickeln wird. Vor zwei Jahren hatte er ein Volumen von nur 1 oder 2 Milliarden US-Dollar, aber die Lancierung von Novo Nordisks GLP-1-Rezeptoragonisten Wegovy hat sich als entscheidender Impulsgeber erwiesen. Wegovy erfüllt in Sachen Wirksamkeit inzwischen die Erwartungen der Patienten und punktet durch geringe Nebenwirkungen. Der Konsens räumt dieser Wirkstoffklasse allein im Bereich Adipositas einen Spitzenumsatz von mindestens USD 30 Mrd. ein.
Warum nimmt dieser Markt so plötzlich Fahrt auf?
In den USA haben die unterschiedlichen Akteure mittlerweile anerkannt, dass Adipositas eine ernst zu nehmende Krankheit darstellt und als solche behandelt werden muss. Daher findet der Markt inzwischen ideale Rahmenbedingungen vor: Die Kosten für Adipositas-Medikamente werden (teilweise) erstattet, Ärzte sprechen sich für diese Präparate aus, es herrscht Nachfrage auf Patientenseite und seit kurzem ist ein wirksames Mittel erhältlich. Die positiven Auswirkungen dieser Medikamente auf die langfristigen Kosten im Gesundheitswesen sind ausreichend bekannt, auch wenn noch umstritten ist, ab welchem Grad der Erkrankung ein positiver pharmakoökonomischer Nutzen erzielt wird.
Welchen Patienten werden die Kosten für Adipositas-Medikamente erstattet?
In den USA wird ein grosser Teil der privaten Krankenversicherungen die Kosten für die Behandlung mit Wegovy voraussichtlich übernehmen. In einigen Fällen sogar bereits ab einem Body-Mass-Index (BMI) von 27, sofern eine Komorbidität vorliegt, wie beispielsweise die Erkrankung an Bluthochdruck. Dabei handelt es sich um einen sehr niedrigen Schwellenwert, denn per Definition gilt ein Patient mit einem solchen BMI nicht als fettleibig! In Europa zeigt sich ein uneinheitlicheres Bild. So erstattet derzeit nur etwa die Hälfte der grössten europäischen Länder die Kosten, macht aber einen höheren BMI als in den USA geltend.
Wegovy ist ein GLP-1-Rezeptoragonist, eine Wirkstoffklasse zur Behandlung von Diabetes. Wie sehen Sie die Zukunft dieser Wirkstoffklasse?
Nach unserem Dafürhalten werden sich GLP-1-Rezeptoragonisten zu einer der bislang grössten Wirkstoffklassen entwickeln angesichts der Vielzahl möglicher Krankheiten, deren Behandlung von einem Eingriff in den Stoffwechsel profitieren könnte. Beim Spitzenumsatz könnte die Wirkstoffklasse monoklonalen PD-1-Antikörpern bei Krebsleiden oder Anti-TNFs bei Autoimmunerkrankungen den Rang streitig machen. Zur Behandlung von Diabetes werden GLP-1-Rezeptoragonisten bereits seit geraumer Zeit eingesetzt, wobei der Behandlungsalgorithmus seitdem weiterentwickelt wurde. Es ist bekannt, dass GLP-1-Rezeptoragonisten bei Diabetikern zu Gewichtsverlust und zur Verringerung kardiovaskulärer Ereignisse beitragen. Wir erwarten weiteren medizinischen Nutzen wie etwa positive Wirkungen bei Nierenerkrankungen oder Fettleber.
Welcher wichtige Impulsgeber steht bei Adipositas-Mitteln als nächster an?
Als bedeutender Katalysator steht zur Jahresmitte die Veröffentlichung der Ergebnisse der klinischen Studie SELECT zu Wegovy an, die den kardiovaskulären Nutzen des Medikaments für die adipöse Patientenpopulation ohne Diabetes untersucht. Fallen die Resultate positiv aus, spräche dies für eine Kostenerstattung des Präparats in den USA und Europa. Dies wiederum würde sich klar positiv auf die Bewertung von Novo Nordisk auswirken. Eli Lilly vertreibt bereits ein GLP-1-Medikament gegen Diabetes und lanciert das Präparat zum Jahresende auch für den Einsatz bei starkem Übergewicht, was den Adipositas-Markt weiter ankurbeln wird.
Gibt es neben Novo Nordisk und Eli Lilly andere nennenswerte Marktakteure?
Beide Unternehmen investieren intensiv in dieses Indikationsgebiet und arbeiten an der Entwicklung oraler Formulierungen und diverser Kombinationstherapien. Abgesehen von diesen beiden Platzhirschen hat Amgen vor Kurzem viel versprechende, frühe Studiendaten vorgelegt. Pfizer verfügt über zwei Wirkstoffe in der mittleren klinischen Entwicklung und Novartis forscht an der Entwicklung eines Mechanismus, der dem Fettabbau dient und den Verlust von Muskelmasse verhindern soll. Diese Konkurrenten hinken jedoch viele Jahre hinter Novo Nordisk und Eli Lilly hinterher.
Novo Nordisk oder Eli Lilly? Welche Aktie hat mehr Potenzial?
Uns gefallen beide Titel, aber wir setzen gegenwärtig stärker auf Novo Nordisk. Novo Nordisk ist die Nummer 1 bei Diabetes und Adipositas, während Eli Lilly deutlich breiter aufgestellt ist. Es stehen zudem Ergebnisse einer anderen Studie von Eli Lilly an, die mit grossen kursrelevanten Unsicherheiten nach oben oder unten behaftet sind, also ein so genanntes «Binary-Event». Da wir stärker an einem reinen Adipositas-Engagement interessiert sind, bevorzugen wir Novo Nordisk.
Autor: Dr. Terence McManus
Dr. Terence McManus kam im Jahr 2022 zu Bellevue Asset Management und ist Portfoliomanager des Bellevue Diversified Healthcare Fonds. Er verfügt über 12 Jahre Erfahrung im Bereich Healthcare-Investments und -Analysen, die er bei Jefferies Investment Bank, Credit Suisse, Julius Baer und zuletzt bei J. Safra Sarasin sammeln konnte. Bei J. Safra Sarasin verwaltete er wo er einen nachhaltigen Gesundheitsfonds. Terence begann seine Karriere als Wissenschaftler, der sich auf die Wirkstoffentdeckung konzentrierte. Er promovierte in Neurowissenschaften an der University of Southampton, UK.
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Bellevue – Excellence in Specialty Investments
Bellevue ist ein spezialisierter Asset Manager mit den Kernkompetenzen Healthcare-Strategien, alternative und traditionelle Anlagestrategien, der an der SIX Swiss Exchange notiert ist. Gegründet 1993, generiert Bellevue als Haus der Anlageideen mit rund 100 Mitarbeitenden attraktive Anlageperformances und somit Mehrwert für Kunden sowie Aktionäre. Per Ende Dezember 2022 verwaltete Bellevue Kundenvermögen in Höhe von CHF 9.4 Mrd.
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